Lecture 6 - Hip/Thigh Ax Flashcards
Largest and most stable joints in the body
Hip joint
Type of joint for hip
Multiaxial ball-and-socket joint
T or F: Humerus is much more stable in the glenoid of the shoulder than the femur is in the acetabulum for the hip
FALSE, femur in acetabulum more stable
Role of the labrum (2)
Deepen and stabilize the joint
3 strong ligaments of the hip
Iliofemoral, ischiofemoral and pubofemoral
Under low loads, the joint surfaces are ___
Under heavy loads, they become ___ ; providing maximum surface contact
Incongruous
Congruous
Hip joint - resting position
Close packed position
Capsular pattern
30° flexion, 30° abduction, slight external rotation
Full extension, medial rotation, and abduction
Flexion -> abduction -> medial/internal rotation
The 3 ligaments limit __ and ___
Pubofemoral limits to ___
Extension and medial rotation
Abduction
Hx - Pain locations and sensations (3)
Anterior
Posterior
Clicking/snapping
Hx - anterior hip pain
Labral tears, impingement
Hx - posterior hip pain
Posterior labral tears, back/pelvis
Hx - clicking and snapping
Internal, external, intra-articular
When hip is affected, length of the step on affected side is ___ so that weight can be taken off leg ____
Shorter / quickly
In standing, the patient commonly has the hip slightly ___ if there is pain in the hip
flexed
What do you look for in observation from front, side and back? (6)
Posture
Symmetry of weight bearing
Balance
Limb positions
Leg length
Ease of movement
Examination (5)
Active movements
Passive movements
Resisted isometric movements
Functional assessment
Special tests
A/P/R for flexion (angle)
110-120°
A/P/R for extension(angle)
10-15°
A/P/R for abduction (angle)
30-50°
A/P/R for adduction (angle)
30°
A/P/R for lateral rotation (angle)
40-60°
A/P/R for medial rotation (angle)
30-40°
Normal end feel - Passive mvts = Flexion
Tissue approximation or tissue stretch
Normal end feel - Passive mvts = Extension
Tissue stretch
Normal end feel - Passive mvts = Abduction
Tissue stretch
Normal end feel - Passive mvts = Adduction
Tissue approximation or tissue stretch
Normal end feel - Passive mvts = Medial rotation
Tissue stretch
Normal end feel - Passive mvts = Lateral rotation
Tissue stretch
Special considerations for resisted isometric movements at the hip
RROM for flexion and extension of knee must be performed because two joints muscle (hamstrings and rectus femoris) act over the knee as well as the hip
Function - Shoe tying
120° of flexion
Function - sitting (average seat height)
112° of flexion
Function - stooping
125° of flexion
Function - squatting
115° of flexion
20° of abduction
20° of medial rotation (internal)
Function - ascending stairs
67° of flexion
Function - descending stairs
36° of flexion
Function - putting foot on opposite thigh
120° of flexion
20° of abduction
20° of lateral rotation (external)
Function - putting on trousers
90° of flexion
Functional tests of the hip (9)
- Squatting
- Going up and down stairs one at a time
- Crossing the legs so that the ankle of one foot rests on the knee of opposite leg
- Going up and down stairs two at a time
- Running straight ahead
- Running and decelerating
- Running and twisting
- One-legged hop (time, distance, power)
- Jumping
Roles/objectives of the special tests (3)
Confirm diagnosis
Determine pathology
Support history, observation, and clinical examination
Special test for the hip (10)
Faber/Fader test
Tests for labrum
Trendelenburg’s sign
Leg length test
Thomas test
Rectus femoris test (Kendal or Mod thomas)
Ober’s test
90-90 straight leg raise test
Specific muscle testing
Flexibility testing
Trendelenburg’s test +ive indicates what
Glute medius diffeciency
2 types of leg length discrepancy
Anatomical/structural or functional
Fulcrum test of the hip
Examiner places arm under femur and carefully applies a downward force at the knee
= Test for femoral stress fracture
Adductor squeeze test
Reproduction of the patient’s pain indicates a positive test for adductor pathology
Read end of ppt for multiple test
p.45-50
T or F: no reflexes around the hip can be evaluated easily
TRUE
True hip pain is usually referred to where?
The groin
See p. 51-52 for dermatomes and sensory distribution
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